Understanding the primary drivers of nursing home hospital admissions
Hospital admissions for nursing home residents represent a significant and complex issue within the healthcare system. The elderly population in these facilities is often frail, suffers from multiple co-morbidities, and is at higher risk for acute health crises. A substantial portion of these transfers to emergency departments and hospitals are driven by a few key medical conditions, with infections and falls being the most prominent. Many of these events are considered potentially preventable, highlighting areas where improved on-site care and communication could make a significant difference.
The leading causes of hospitalization
Infections: The top cause of admission
Infections consistently top the list of reasons for hospital transfers from nursing homes. Residents are more susceptible to infections due to weakened immune systems, close living quarters, and pre-existing conditions. Infections can escalate quickly, leading to more severe conditions like septicemia, which often necessitates hospitalization for advanced treatment.
- Pneumonia: Respiratory infections, including pneumonia, are a major driver of admissions. Nursing home-acquired pneumonia can be particularly severe and carries a higher mortality risk compared to community-acquired cases. Efforts like vaccination and improved clinical pathways have been shown to reduce hospitalizations from pneumonia.
- Urinary Tract Infections (UTIs): UTIs are another very common cause, often presenting with non-specific symptoms in elderly residents, such as altered mental status rather than typical urinary pain. Without prompt and appropriate care, UTIs can quickly lead to sepsis.
- Sepsis: This life-threatening complication of infection is a frequent diagnosis for hospitalized nursing home residents, and for Medicare patients, it is the number one cause. It is often a result of an untreated or poorly managed infection, such as pneumonia or a UTI, that has progressed into a systemic inflammatory response.
Falls and related injuries
Falls are the second most common reason for hospital admissions from nursing homes. A simple fall for a frail, older adult can result in serious consequences, including hip fractures and head injuries, that require immediate and intensive medical intervention. Hip fractures, in particular, are a frequent outcome of falls among this population. Many factors contribute to the high rate of falls, including muscle weakness, cognitive impairment, and environmental hazards within the facility.
Exacerbation of chronic conditions
Nursing home residents typically live with multiple chronic illnesses, and a sudden worsening of these conditions is another primary reason for hospital transfer. Conditions that are manageable within the nursing home can become acute and require advanced hospital care.
- Congestive Heart Failure (CHF): A significant portion of potentially avoidable hospitalizations involve CHF exacerbations. A sudden worsening of symptoms like shortness of breath or edema requires hospital-level care for proper management and stabilization.
- Chronic Obstructive Pulmonary Disease (COPD): Acute exacerbations of COPD and asthma are frequently cited reasons for hospitalization. These respiratory crises can overwhelm the nursing home's capabilities, leading to a transfer for oxygen support and more intensive treatment.
- Dehydration: Malnutrition and dehydration can also prompt hospital admissions, particularly when a resident is unable or unwilling to eat or drink sufficiently due to illness or cognitive decline. This is another condition often identified as potentially preventable with better monitoring and intervention.
A comparison of major causes for admission
This table provides a high-level comparison of the most common acute conditions leading to hospital transfers from nursing homes.
| Reason for Admission | Severity | Potential for Prevention | Common Symptoms in NH Residents |
|---|---|---|---|
| Infections | High, can lead to sepsis | Moderate to High | Fever, altered mental status, lethargy, decreased appetite |
| Falls | High, can cause fractures | Moderate to High | Sudden loss of balance, injury, pain, disorientation |
| Congestive Heart Failure (CHF) | High, requires immediate treatment | Moderate | Shortness of breath, swelling (edema), fatigue |
| COPD Exacerbation | High, requires respiratory support | Moderate | Increased shortness of breath, wheezing, coughing |
| Dehydration | Moderate to High | High | Confusion, lethargy, dry mouth, decreased urination |
Reducing potentially avoidable hospitalizations
Preventing hospital transfers is a primary goal for many nursing homes and healthcare systems, not just to reduce costs but also to improve resident outcomes. Hospitalization can lead to a decline in a resident's functional and cognitive status, increase the risk of hospital-acquired infections, and create significant distress for the individual.
Interventions like the INTERACT program (Interventions to Reduce Acute Care Transfers) provide practical tools and training for nursing home staff to better identify, assess, and manage acute changes in a resident's condition. These tools, combined with better communication among staff and physicians, can empower nursing home teams to treat more conditions in place.
Another critical element is advanced care planning. Having clear documentation of a resident's wishes for end-of-life care, such as a Physician Orders for Life-Sustaining Treatment (POLST) form, can prevent unwanted or burdensome hospitalizations for individuals with terminal illnesses.
Key strategies for reduction:
- Enhanced staff training: Providing education for nursing staff on symptom recognition and management can lead to earlier intervention.
- Improved communication: Better communication between nursing staff, physicians, and families can ensure timely and appropriate care decisions are made.
- Advanced care planning: Regularly discussing and documenting a resident's goals and preferences for care can guide decisions during acute illness.
- On-site resources: Ensuring access to necessary equipment and expertise, such as lab tests and intravenous therapy, can allow more residents to be treated in the nursing home.
Conclusion
While a variety of factors contribute to the transfer of nursing home residents to hospitals, infections and falls consistently stand out as the most common causes. The frailty and multiple chronic conditions of this population make them particularly vulnerable to these events, many of which are considered potentially preventable. By focusing on enhanced staff training, improved communication, proactive care planning, and better on-site resources, nursing homes can significantly reduce unnecessary hospitalizations, improving both the quality of care and overall health outcomes for their residents.
Learn more about hospital transfers and readmission on HHS.gov
